AccountId: 011433970860
ContactId: 59f791e5-1227-4e11-947a-5de4bdb993dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 729159 ms
Total Talk Time (AGENT): 223008 ms
Total Talk Time (CUSTOMER): 170329 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/59f791e5-1227-4e11-947a-5de4bdb993dc_20250331T19:00_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I wanna check um benefits for one patient.
[AGENT][POSITIVE] OK, I can help you with benefits. Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII] Callback number is [PII].
[AGENT][POSITIVE] OK, and I'm sorry, could you spell your first name again? I'm so sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let's see. OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, the policy number is.
[CUSTOMER][NEUTRAL] 02563094
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And patient name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is not a guarantee of payment. It's just a basic outline of the policy. I show she is active and effective [PII].
[AGENT][POSITIVE] And I can send a fax back that outlines the entire policy, um, or we can go over the policy now, whatever is easiest for you.
[CUSTOMER][NEUTRAL] Uh, yes, if you can get go over the policy right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, for this one, was there any major coverage?
[AGENT][NEUTRAL] Um, let's see, so she has a $500 calendar, your maximum benefit. She does not have any major coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for no Crohn's, no oral surgery, correct?
[AGENT][NEUTRAL] Um, there might be oral surgery. Let me check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would it be like a simple extraction or?
[CUSTOMER][NEUTRAL] Yes, um, I do have a few codes. I did wanna check.
[CUSTOMER][NEUTRAL] Just in case.
[AGENT][NEUTRAL] OK, what's the code?
[CUSTOMER][NEUTRAL] Oh, did you want them all once or just one by one?
[AGENT][NEUTRAL] Uh, we can just do one by one.
[CUSTOMER][NEUTRAL] Uh, it can be 7140.
[AGENT][NEUTRAL] Yes, that's covered under basic, pays 80% after a $50 deductible.
[CUSTOMER][NEUTRAL] OK, and then for the 7 to 10?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] I don't show that listed under the policy.
[CUSTOMER][NEUTRAL] OK, and then for the 7 to 20.
[AGENT][NEUTRAL] Uh, I don't show that either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then 72:30.
[AGENT][NEUTRAL] Uh, don't show that either.
[CUSTOMER][NEUTRAL] 7240.
[AGENT][NEUTRAL] Uh, don't show that either. The only thing, the only seven code I have is [PII] and [PII]. Those are the 27 codes that I have.
[CUSTOMER][NEUTRAL] OK, and then [PII]?
[AGENT][NEUTRAL] Uh, 2610, is that what you said?
[CUSTOMER][NEUTRAL] 6010.
[AGENT][NEUTRAL] 0, 6010. OK, sorry about that. Um, don't show that listed.
[CUSTOMER][NEUTRAL] Uh, and then 6104?
[AGENT][NEUTRAL] Um, I don't show any 6 series codes listed.
[CUSTOMER][NEUTRAL] OK, and then 79 OK sorry.
[CUSTOMER][NEUTRAL] And then 9230?
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Only 9 series codes I have are 9110 and 9310.
[AGENT][NEUTRAL] Those are basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for the simple extraction, the 7140, does it go through medical or dental?
[AGENT][NEUTRAL] Um, I don't know about medical, uh, just this is a dental policy, so it's considered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what would be the group name of the insurance?
[AGENT][NEUTRAL] Uh, let's see, that is.
[AGENT][NEUTRAL] Uh, it looks like Lark LLC.
[CUSTOMER][NEUTRAL] What was the name?
[AGENT][NEUTRAL] Uh lark, L A R K L L C.
[AGENT][NEUTRAL] And which is part of on track staffing.
[CUSTOMER][NEUTRAL] OK, so it is Lark LLC correct for the group name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then the name of the insurance was it Carrington?
[AGENT][NEUTRAL] Um, Carrington.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So Carrington is a PPO network for dental. We don't require that, but if they'd like, you know, if you're part of Carrington, then that's fine.
[CUSTOMER][NEUTRAL] What kind of insurance is this?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK and then what would be the group number?
[AGENT][NEUTRAL] Group number 70083.
[CUSTOMER][POSITIVE] Alright, thank you. And then for Eno Donnis, would that be considered a major?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] OK. And then for oral surgery as well, correct?
[AGENT][NEUTRAL] Yes, besides the 7140, yes.
[CUSTOMER][NEUTRAL] And then 4 43 41?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] Um, I don't have any 4 series codes on here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Was there any history on this plan?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] why
[CUSTOMER][NEUTRAL] get out.
[AGENT][NEUTRAL] Um, I don't show anything used this year.
[CUSTOMER][NEUTRAL] And this runs back on the year correct?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Does this plan run by calendar year?
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] OK, and then she hasn't used any of the annual max or used the individual deductible, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and then for the deductible it applies to basic only correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the the the provider, will they be in or out of network?
[AGENT][NEUTRAL] Um, I don't have information on Carrington, but I can give you their number.
[AGENT][NEUTRAL] If you're in network with them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We don't use a network, but if, if you want to check and see if you're part of Carrington, I'm, I can give you their number.
[CUSTOMER][NEUTRAL] OK, then it should be fine. So what kind of insurance is this one?
[AGENT][NEUTRAL] Uh, it's a dental policy.
[CUSTOMER][NEUTRAL] Yes, if it's you say we can choose what kind of insurance it is if we can choose Carrington.
[AGENT][NEUTRAL] Yeah, so it's
[CUSTOMER][NEUTRAL] And how does that work?
[AGENT][NEUTRAL] So, um, it looks like.
[AGENT][NEUTRAL] We don't have networks because we're APL, but they can use Carrington because if they use Carrington then there would be a discount I believe.
[AGENT][NEUTRAL] It's just not required by us for the claim to be filed.
[AGENT][NEUTRAL] So it's just a second, it's an option, so.
[AGENT][NEUTRAL] To use the dental Carrington Dental PPO network.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] And then what would be the claim address?
[AGENT][NEUTRAL] Claim address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then for the code 1208, would that be a cover benefit?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Uh, let me pull up policy back up.
[AGENT][NEUTRAL] Um, I don't show 1208 on here.
[CUSTOMER][NEUTRAL] OK and then for the 1351.
[AGENT][NEUTRAL] Um, for sealants, that's for.
[AGENT][NEUTRAL] Um, that's covered with an age limit for dependent children.
[AGENT][NEUTRAL] Uh, [PII] is that what you're waiting for.
[AGENT][NEUTRAL] Uh, dependent children, I'm sorry, uh, yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah, dependent children under age [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, that should be um if.
[CUSTOMER][NEUTRAL] can you get a number.
[AGENT][NEUTRAL] The reference number is just my first name, [PII], last initial [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Right.